US Public Health Service's Healthy People 2010 initiative has highlighted the need for a greater research focus on remedying the race and gender disparity in mental health and outcome of coronary heart disease (CHD). While CHD mortality has declined among men, it has continued to increase among women, claiming the lives of more than half a million women every year. Depression predicts adverse outcomes after myocardial infarction (Ml) and is far more prevalent among women than men post-MI. Therefore, it is possible that depression is an important determinant of women's poorer prognosis post-MI. However, there is limited information on this issue. There is also paucity of clinical trials examining pharmacological treatment of depression in post-MI patients. Since African-Americans have a major burden of unmet mental health needs, it is relevant to conduct such a trial in an African-American population. Accordingly, the specific aims for the research plan are: 1) to examine to what extent depression accounts for women's higher rates of adverse outcomes post-MI; 2) to determine whether the association between depression and outcome is the same or differs in men and women; and 3) to examine, in a preliminary fashion, the efficacy of drug treatment of depression in improving outcome in post-MI men and women in a predominantly African-American patient population. This study will be conducted in collaboration with the General Clinical Research Center (GCRC) at Emory. If successful, our study will advance understanding of the factors associated with the poorer outcome after Ml and provide novel effective ways to improve outcomes in women, as well as in men. Our study has the potential to demonstrate that treatment of depression improves outcomes after Ml and contribute to remedying race and gender differences in outcomes of Ml patients. The environment is ideal for the proposed career development. Emory University has an established infrastructure through NIH K30 and K12 programs and GCRC for career development of clinical investigators and is home to several original research projects on CHD. The Lead Mentor and Advisory Committee members are expert clinical investigators with commitment to fostering the candidate's career development. The candidate's long term goal is to become an independent patient-oriented investigator focusing on the role of psychological, behavioral and biological factors that influence cardiovascular disease (CVD) outcomes and the impact of novel interventions on eliminating disparity in outcomes. To meet these goals, the proposed individualized multidisciplinary career development plan integrates training in mentored patient-oriented research, advanced statistical, epidemiological and behavioral research methods, and collaboration with GCRC and CVD outcomes researchers both at Emory and other national institutions.